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  • Title: Extraamniotic prostaglandin F2 alpha for intrauterine death and fetal abnormality.
    Author: Luengo J, Keirse MJ, Bennebroek Gravenhorst J.
    Journal: Eur J Obstet Gynecol Reprod Biol; 1977; 7(5):325-9. PubMed ID: 299460.
    Abstract:
    Prostaglandin F2 alpha was administered extraamniotically for termination of pregnancy in 15 cases of intrauterine fetal death between 18 and 39 wk gestation and in 10 cases of fetal abnormality or hydatidiform mole between 16 and 28 wk gestation. Although delivery was achieved with minimal side effects in all cases, the best results were obtained in patients with intrauterine fetal death. It is concluded that discontinuous extraamniotic prostaglandin therapy constitutes a safe and effective approach for the active management of intrauterine fetal death. Prostaglandin F2alpha (PGF2alpha) was administered extraamniotically for pregnancy termination in 15 cases of intrauterine fetal death between 18-39 weeks gestation and in 10 cases of fetal abnormality or hydatidiform mole between 16-28 weeks gestation. After thorough cleansing of the cervix a No. 16 Foley catheter was inserted and retained in the extraamniotic space by means of the balloon, inflated with 10 ml of saline. PGF2alpha tromethamine salt (Prostin F2alpha, Upjohn Netherland, was diluted to an aqueous solution of 0.25 mg PGF2alpha/ml and administered via the catheter at 1 hour intervals. Treatment was started with 0.5 mg (2 ml) and the initial dosage was increased by increments of 0.25 mg to a maximum of 1 mg/hour if uterine contractility did not ensue. Temperature, pulse rate, and blood pressure were checked regularly. Antibiotherapy (ampicillin) was routinely given at the beginning of the study but later abandoned. Pethidine was used as an analgesic whenever required. Abortion or delivery was achieved in all 25 cases studied. In all but 1 of the patients with intrauterine fetal death, delivery occurred within 24 hours and the placenta was delivered spontaneously and complete in 11 of the 15 patients (73%). There was no relationship between the duration of fetal death and induction delivery interval. In cases with an abnormal but living fetus or hydatidiform mole, abortion was frequently incomplete and the mean induction abortion interval (24.4 hours) was 10 hours longer than that observed in cases of intrauterine fetal death (14.5 hours). 5 of the 10 patients required intravenous oxytocin from a cervical dilatation of 3-6 cm onwards and from 14-30 hours after the start of PGF2alpha administration. In these cases abortion always followed within 3 hours of starting the oxytocin infusion. Side effects were moderate in both groups of patients and pyrexia of 38 degrees Centigrade or more was never encountered. None of the patients showed any signs of intrauterine infection. Blood loss exceeded 500 ml in 4 of the 25 patients studied (16%), but only 1 patient, with a molar pregnancy, lost as much as 1000 ml. Discontinuous extraamniotic prostaglandin therapy constitutes a safe and effective approach for the active management of intrauterine fetal death.
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